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At least 361 records · Page 20Linked to original sources
PubMed2005

The reliability and validity of patient self-rating of their own voice quality.

OBJECTIVES: To provide preliminary data on the reliability and validity of dysphonic patients rating their own voice quality. DESIGN: Prospective reliability/validity assessment of voice ratings in dysphonic patients. SETTING: The Royal Free Hampstead NHS Primary Care Trust. PARTICIPANTS: Thirty-five adult dysphonia patients recruited from ENT referrals to a speech and language therapy department. Exclusion criteria were (i) a hearing impairment which may affect auditory discrimination and (ii) a diagnosis of cognitive impairment which may affect task comprehension. MAIN OUTCOME MEASURES: Patient intra-rater reliability was assessed by test-retest ratings, using G (Grade), R (Rough), B (Breathy), A (Asthenic), S (Strained) (GRBAS). Validity was assessed by comparing (i) patient-clinician inter-rater reliability, (ii) patients' GRBAS ratings with their Vocal Performance Questionnaire (VPQ) responses. RESULT: (i) Patients had lower intrarater reliability than clinicians (for G of GRBAS, kappa = 0.51 versus 0.74); (ii) patients consistently rated their voices more severely than clinicians (for G of GRBAS, mean rating = 1.4 versus 1.0); (iii) clinician-patient inter-rater agreement was no better than chance (paired t-test, all P < 0.05); (iv) patient ratings correlated significantly with vocal performance scores (r > 0.4, P < 0.05). CONCLUSIONS: Patients appear to have good validity and consistency using GRBAS as a self-perception tool. However, validity measured in terms of agreement with clinician ratings is poor. Voice patients may rate what they perceive rather than what they hear. Disagreement between patient and clinician ratings has implications for therapy aims, prognosis, patient expectations and outcomes. Where disagreement persists, the clinician may have to determine whether therapy priorities need redesigning to reflect patients' perceived needs, or to evaluate whether patient perceptions and expectations are unrealistic.

Adult↗
PubMed2006

Validation of a voice prosthesis questionnaire to assess valved speech and its related issues in patients following total laryngectomy.

OBJECTIVES: To establish the reliability and validity of a new self-administered questionnaire to assess valved speech and its related issues in patients who have undergone a total laryngectomy operation. DESIGN: Cross-sectional psychometric validation study. SETTING: Tertiary cancer care centre. PATIENTS: We identified sixty-one total laryngectomy patients with no sign of recurrent disease and using voice prosthesis from the speech and language therapy database of the Royal Marsden Hospital. The patients were assessed using a postal self-administered voice prosthesis questionnaire concerning the voice valve and it's related issues. Patients were also asked to complete the University of Michigan voice related quality of life and University of Washington head and neck quality of life (version 4) questionnaires. MAIN OUTCOME MEASURES: Test-retest and internal consistency reliability; content; criterion and construct validity. RESULTS: We received completed questionnaires from fifty-one of the sixty-one total laryngectomy patients identified for the study providing a response rate of 84%. The median age of the group was 65 years (range: 40-85) with thirty-seven males and fourteen females. The internal consistency reliability using the Cronbach's alpha coefficient was 0.87 (range: 0.85 to 0.89). Test-retest reliability showed that more than 75% of patients had a score on re-test that was within 1 point of their original score. Content validity was ensured during the design process. The median Spearman correlation coefficient was 0.25 for convergent construct validity with the University of Washington head and neck quality of life questionnaire and 0.64 for criterion validity on comparison with the University of Michigan voice related quality of life scale. CONCLUSIONS: The voice prosthesis questionnaire is the first validated and reliable self-administered questionnaire designed specifically for evaluating valved speech and its related issues in patients who have undergone total laryngectomy. The voice prosthesis questionnaire has significant utility for audit, outcomes research and monitoring in this unique group of patients.

Adult↗
PubMedDate not supplied

Developmental stuttering: manifestations, treatment and dental implications.

Developmental stuttering (DS) is a disturbance in the normal fluency and time patterning of speech resulting in involuntary repetition, prolongation, or cessation of sound. The scientific literature has implicated the lack of strong left cerebral dominance and abnormal levels of the neurotransmitters dopamine and possibly serotonin in regions of the brain controlling the coordination of language processing and motor activity of the vocal apparatus as possible causative factors in DS. Speech-language therapy is the most common form of treatment, but antipsychotic, antidepressant, and anxiolytic medications may be prescribed for some children and adults with persistent stuttering. These medications may cause xerostomia and adversely interact with certain antibiotics, analgesics, and sedatives routinely used in dentistry. Some people who stutter have sensory-motor and tactile-proprioceptive deficits that impede accurate and timely movements of the mandible, lips, and tongue, necessitating protection of the airway by staff during dental care.

Anti-Anxiety Agents↗
PubMed1981

Word deafness in Wernicke's aphasia.

Three patients with otherwise typical Wernicke's aphasia showed consistent superiority of visual over auditory comprehension. The precedents for and anatomical basis of a selective auditory deficit in Wernicke's aphasia are discussed, including the relationship to pure word deafness. One implication of spared visual language function may be the use of gesture in language therapy for such patients.

Aphasia↗
PubMed2001

Rediscovering the joy of food: the need for long-term review of swallowing ability in stroke patients.

Stroke is commonly associated with dysphagia, which may necessitate the use of enteral feeding best provided by a percutaneous endoscopic gastrostomy (PEG) tube. Resolution of dysphagia complicating stroke is observed in the days, weeks and months following the event. This may allow the resumption of a normal diet, and cessation of enteral feeding. However at the time dysphagia resolves many patients--with enteral feeding still in place--will have been discharged from facilities where expert speech and language therapy is available to assess recovery of swallow. We report three cases of patients with dysphagia following stroke who benefited from long term review of swallowing ability. We then discuss the benefits of such follow-up, and how it might best be achieved in the community.

Aged↗
PubMed2002

Systematic reviews in rehabilitation for stroke: issues and approaches to addressing them.

OBJECTIVES: To describe the problems encountered when undertaking systematic reviews of rehabilitation and to give advice to reviewers about ways of addressing these issues. BACKGROUND: Evidence-based practice has become established as a way of linking clinical practice with research evidence. The most robust evidence is usually considered to be that from randomized controlled trials, and from systematic reviews of these trials. However, most reviews have focused on drug and surgical interventions, and few reviews have been produced in the field of rehabilitation. This may be due to the unique difficulties that are posed by reviews in this area. EXPERIENCE OF SYSTEMATIC REVIEWS IN APHASIA: We describe the challenges that occurred when carrying out systematic reviews of speech and language therapy for aphasia following stroke, and of ways to deliver rehabilitation services to people who have suffered a stroke. Issues arose at all stages of the reviews and included: using expertise; planning the review; defining the health care problem, patients, outcomes and interventions of interest; searching for, interpreting and synthesizing the results of the studies identified; and deriving implications from the review. Suggestions made to address these challenges include: developing a suitable team of reviewers; using inclusive and broad criteria for inclusion of trials to a review; developing appropriate search strategies; and using caution in arriving at conclusions. It is important to be explicit about decisions made during the review process concerning how to handle the challenges. Practical advice about carrying out reviews in the field of stroke rehabilitation is likely to be helpful to reviewers of other rehabilitative interventions. There are likely to be relatively few studies available for such reviews, and limitations in drawing specific practical conclusions. Such undertakings are, however, useful in setting the agenda for further research.

Humans↗
PubMed2001

Food refusal and dysphagia in older people with dementia: ethical and practical issues.

Food refusal poses difficulties for nurses and care staff and can place older patients with dementia at risk of undernutrition. The dangers of and reasons for food refusal in these patients are explored and the fundamental ethical and legal issues raised in caring for these patients are examined. Practical guidance and solutions are offered through dietetics and speech and language therapy with the aim of helping nurses and care staff, as well as professional carers in palliative care, and explore ways of critically examining and coping with these dilemmas.

Aged↗
PubMed2001

Sharing stories: life history narratives in stuttering research.

The life experiences of people who stutter (PWS) have not featured prominently in research. Historically, the profession of speech and language therapy has amassed data and developed its theory of stuttering within a positivistic frame. As a consequence, the existing over-arching theory of research and practice does not engage holistically with the dynamic personal, socio-cultural and political contexts of the individual who stutters. Therefore a conceptual shift is required in ontology, epistemology and methodology underpinning the knowledge construction process. The use of the life history narratives as a research tool is promoted. An exploratory study of a single participant is presented to illuminate the methodological approach and emerging theoretical constructs.

Adaptation, Psychological↗
PubMed2001

Dysphagia training for nurses in an acute hospital setting--a pragmatic approach.

Dysphagia assessment and management has significant impact on speech and language therapy (SLT) resources. Recent reports have highlighted nurses' role in the nutrition of their patients. In order to focus SLT input efficiently and effectively and to improve nurse confidence in management of patients with swallowing problems, a dysphagia screening test (DST) was devised for use by nurses within an acute teaching hospital setting. This has since been used for training SLT students and junior doctors.

Deglutition Disorders↗
PubMed1995

Speech pattern audiometry for clinical use.

A new PC-based speech perception testing system ('speech pattern audiometer') is described which aims to provide a simple and efficient clinical tool to assess patients' ability to make use of the acoustic speech pattern information which is fundamental to speech perception. The speech pattern audiometer is likely to find its main application in audiology and speech and language therapy clinics with those who are deaf or who have developmental or acquired speech-perceptual disorders. This system constitutes a module of a complete speech and hearing assessment and teaching/therapy workstation.

Audiometry, Speech↗
PubMed1995

Using electropalatography to treat severe acquired apraxia of speech.

This paper reports on the use of electropalatography (EPG) in the treatment of a patient with severe acquired apraxia of speech. At 2 years post-onset and after a period of conventional speech and language therapy, the patient, AD, presented with severe speech production problems affecting articulation, phonation and resonance. Treatment using EPG is described and both the patient's progress and his continued limitations are outlined. EPG provided a valuable form of visual feedback for the patient and revealed and clarified aspects of oral movements for speech and non-speech activity which had been difficult to capture via auditory perception.

Apraxias↗
PubMed1998

The development of a bilingual phonology assessment.

This paper describes the development of a phonological assessment procedure for children speaking Mirpuri, Punjabi or Urdu in combination with English. The Rochdale Assessment of Mirpuri Phonology (RAMP) was produced in response to the practical difficulties of a monolingual therapist wishing to assess a child's phonological systems across all languages used. The assessment is currently being used both as a clinical tool within the Rochdale Healthcare NHS Trust Speech and Language Therapy Department and as a research tool in collaboration with the Department of Speech, University of Newcastle to provide further data on patterns of bilingual phonological acquisition. Outcomes include therapy targeted more accurately at deficits within each phonological system.

Child↗
PubMed1998

The value of single-case research.

This paper presents an argument in support of clinic based research. The role that the clinic-based speech and language therapist has in advancing our knowledge of communication disorders and their treatment is emphasised. The value of single-case research within the field of speech and language therapy is discussed and the arguments are presented with respect to stammering. A single case study of pre-school dysfluency is used to illustrate the potential for conducting research using this methodology in a clinical environment.

Humans↗
PubMed1998

An anger management programme for adults with learning disabilities.

Speech and language therapy aims to increase the functional communication of adults with learning disabilities through the implementation of interaction group programmes but the full therapeutic benefit may be reduced because of individual clients' presenting challenging behaviours. The pilot Anger Management Programme aimed to reduce clients' challenging behaviour through increased communication use and with a focus on multidisciplinary collaborative NHS health trust and social work team working practices. An in-service training package and two client-group programmes were devised and positively received both from a client provision and multidisciplinary skill-merge perspective. The paper details the introduction to the study, its objectives, methodology and qualitative analysis.

Adult↗
PubMed1998

When staff training isn't enough: an evaluation of a collaborative approach.

This paper describes an evaluation of a training workshop for staff working with people who have severe physical and learning disabilities and who need extensive support with eating and drinking. Training involved joint input from speech and language therapy, dietetics, occupational therapy and physiotherapy and was evaluated at three levels: participants' satisfaction, gains in knowledge and video-tapes of mealtimes pre- and post-training to assess changes in practice. Results indicated very positive staff perceptions of the workshops and highly significant increases in knowledge, both immediately (p < 0.001) and after six months (p < 0.001). However there was no evidence of significant change in practice. Results are discussed in the context of bringing about changes in staff behaviour.

Caregivers↗
PubMed1998

Challenging communication: people with learning disabilities who challenge services.

This paper describes a project designed to equip direct care workers with the knowledge and skills to address communication as a central factor in the lives of people with learning disabilities who challenge services. The elements of the approach taken--'Challenging Communication'--are described, outcomes discussed and possible implications for the speech and language therapy profession briefly considered.

Caregivers↗
PubMed1998

The measurement of intervention effects in developmental phonological disorders.

The effectiveness of speech and language therapy for developmental phonological disorders has typically been measured in terms of the diminution of the application of phonological processes. Often substantial amounts of intervention and time may be needed to show up such changes. Shorter and more clinically realistic intervention regimes can result in small but significant changes in speech production which represent positive developments in the phonological system. In order to measure progress in this sort of therapy a sensitive instrument of measurement is required. In this paper we describe a research measurement tool, the probe scoring system, which was designed to detect small changes in the child's phonological system following therapy and contrast it to some of the instruments selected for use in other efficacy studies. The potential for wider clinical application is also considered.

Child↗